The preoperative combination of evolocumab and rosuvastatin may not reduce major adverse cardiovascular events

1. Preoperative evolocumab combined with rosuvastatin did not significantly reduce six-month major adverse cardiovascular events but improved several clinically relevant secondary outcomes.

2. Early intensive lipid-lowering was associated with reduced angina, faster low-density lipoprotein cholesterol reduction, improved myocardial reperfusion, and attenuated inflammation after ST-elevation myocardial infarction.

Evidence Rating Level: 1 (Excellent) 

Early lipid-lowering and attenuation of inflammation may improve myocardial reperfusion and symptoms in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. This prospective, randomized, single-center trial evaluated whether a single preoperative dose of evolocumab combined with rosuvastatin improves clinical and biological outcomes compared with rosuvastatin alone. Eighty statin-naïve patients with acute ST-elevation myocardial infarction were randomized to receive evolocumab 140 mg subcutaneously plus rosuvastatin 10 mg before intervention, followed by rosuvastatin maintenance, or rosuvastatin initiated after intervention alone. The primary endpoint was major adverse cardiovascular events at six months. Secondary endpoints included angina incidence, serial low-density lipoprotein cholesterol measurements, inflammatory markers, and ST-segment resolution after intervention. At six months, the incidence of major adverse cardiovascular events was lower in the combination therapy group, but did not reach statistical significance. However, patients receiving preoperative evolocumab experienced significantly fewer angina episodes, more rapid and greater reductions in low-density lipoprotein cholesterol during the early post-intervention period, improved ST-segment resolution, and lower postoperative interleukin-6 and interleukin-17 levels. Differences in lipid levels were no longer significant beyond one month. No excess hepatic, renal, or muscular adverse events were observed. Overall, preoperative evolocumab combined with rosuvastatin improved early lipid, inflammatory, and reperfusion markers and reduced angina burden, supporting further investigation of early intensive lipid-lowering strategies in acute ST-elevation myocardial infarction.

Click here to read this study in PLOS One

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